Gender disparities in transplantation

Abstract

Purpose of review Transplantation is the life-saving therapy for patients suffering from end-organ failure, and as such, equitable access to transplantation (ATT) is of paramount importance. Unfortunately, gender/sex-based disparities exist, and despite the transplant community's awareness of this injustice, gender/sex-based disparities have persisted for more than two decades. Importantly, no legislation or allocation policy has addressed inequity in ATT that women disproportionately face. In fact, introduction of the model for end-stage liver disease-based liver allocation system in 2002 widened the gender disparity gap and it continues to be in effect today. Moreover, women suffering from kidney disease are consistently less likely to be referred for transplant evaluation and subsequently less likely to achieve a kidney transplant, yet they comprise the majority of living kidney donors. Recent findings Acknowledging gender/sex-based disparities in ATT is the first step toward interventions aimed at mitigating this long-standing injustice in healthcare. Summary This article provides a background of end-stage liver and kidney disease in women, summarizes the existing literature describing the issue of gender disparity in ATT, and identifies potential areas of intervention and future investigation.

Addressing the Ethical Challenges of Providing Kidney Failure Care for Children: A Global Stance

“…Women compose the majority of kidney donors worldwide ( 29 , 74 , 98 ). Living kidney donation is associated with surgical risk and the possibility of CKD in the long-term.…”

Perception of social inequities in the access to the kidney transplant waiting list by nephrology trainees: a national survey

“…Their assumption was that older and sicker women were probably more likely misclassified (or they misclassified themselves) as too frail to undergo a kidney transplant. In contrast, Sheikh et al [25] demonstrated that women were more compliant and had equal or better outcomes after transplant than men. A study conducted in the US highlighted the fact that women undergoing haemodialysis were less likely than men to have discussions about kidney transplantation as a treatment option [19].…”

The sex disparity in liver transplantation

“…Exception points have been awarded to groups whose mortality is not reflected in the MELD-Na score, such as hepatocellular carcinoma (HCC) patients. Despite these strides, women have remained persistently disadvantaged in their access to LT. Women have had increased wait list mortality and lower transplant rates for several decades [2].…”

“…This disparity has largely been attributed to sex bias in the MELD allocation and exception point system as well as difficulties in donor and recipient size matching as a result of the smaller size of female recipients [2]. However, many studies demonstrate that gender inequity may be more complicated and nuanced than bias within the allocation system [3 ▪ ].…”